Healthcare Provider Details

I. General information

NPI: 1609968452
Provider Name (Legal Business Name): RUSSELL C. RAPHAELY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A.I. DUPONT HOSPITAL FOR CHILDREN 1600 ROCKLAND ROAD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

NEMOURS CHILDRENS CLINIC P.O. BOX 404112
ATLANTA GA
30384-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4000
  • Fax: 302-651-4945
Mailing address:
  • Phone: 904-390-3610
  • Fax: 904-288-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC10005241
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberC10005241
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberC10005241
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMA06427200
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD007844E
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMA06427200
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD007844E
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMA06427200
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD007844E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: